Individual
DR. JAY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
N-236 NORTH GARDEN, MALL OF AMERICA, BLOOMINGTON, MN 55425
(952) 854-4500
(952) 858-8525
Mailing address
3333 HAZELTON RD, EDINA, MN 55435-4204
(952) 926-5300
(952) 915-9212
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MN1697
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190P9PE
BCBS/MN
MN
01
—
2203100
MEDICA/UNITED HEALTH CARE
MN
01
—
23713
AMERICA'S PPO
MN
01
—
MN1697
EYEMED
MN
Enumeration date
09/07/2006
Last updated
07/08/2007
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